Medicare Financial and Signature On File Form

Instructions: Please click below to open this form. Then print it out on your printer, read it, sign it, and then please bring it with you to your first appointment. Please click on our General Office Policies section for important new patient information.

Click here to view and print this form.

To view the document above you may need a free program called Adobe Reader®. This program may already be on your computer. If not you can download it for free by clicking on the link.